Coping Style as a Predictor of Relapse and Functioning in First Episode Psychosis

Background: Compromised coping responses to life stressors may influence the development, maintenance, and recovery of psychosis. <br/><br/>Study Design: A longitudinal design assessed 269 FEP patients at baseline, 4, 8, and 12 months. Linear/logistic regressions and machine learning techniques evaluated whether baseline coping styles predicted clinical and functional outcomes.<br/><br/>Results: Relapse occurred in 22 (9%), 35 (14%), and 50 (20%) participants within 4, 8, and 12 months, respectively. Maladaptive coping was associated with higher odds of relapse within 12 months (OR = 1.06, 95% CI: 1.00–1.12), hallucinations (OR = 1.07, 95% CI: 1.01–1.13) and delusions (OR = 1.07, 95% CI: 1.02–1.13), and with poorer GAF symptom and disability scores across follow-up. Adaptive coping was significantly associated with lower odds of hallucinations (OR = 0.96, 95% CI: 0.92–1.00) and delusions (OR = 0.95, 95% CI: 0.91–0.99) and with better functioning at 4 months (B = 0.35, SE = 0.13). Machine learning indicated that maladaptive (AUC = 0.770, ACC = 0.750) and adaptive coping (AUC = 0.729, ACC = 0.696) were significantly associated with relapse within 12 months, with maladaptive coping showing stronger predictive accuracy. Key contributors included self-distraction and substance use for maladaptive coping, and spiritual/religious coping and active problem-solving for adaptive coping.<br/><br/>Conclusions: Baseline coping styles were associated with clinical and functional outcomes in FEP. These findings suggest that targeting maladaptive coping, particularly self-distraction and substance use, while promoting active problem-solving and spiritual/religious coping, may inform future intervention development aimed at improving symptom trajectories and long-term functional recovery.<br/>